老年骨髓增生异常综合征患者重组人白细胞介素11治疗后心律失常的临床观察  

Clinical observation of arrhythmia after treatment with recombinant human interleukin 11 in elderly patients with myelodysplastic syndromes

作　　者：陈钊 周明[2] 陈建英 刘显庆[3] 曾福仁 

机构地区：[1]湖南师范大学第一附属医院、湖南省人民医院血液风湿科,长沙410016 [2]湖南师范大学第一附属医院、湖南省人民医院血液科,长沙410016 [3]湖南师范大学第一附属医院、湖南省人民医院心血管科,长沙410016 [4]湖南师范大学第一附属医院、湖南省人民医院肿瘤科,长沙410016

出　　处：《白血病．淋巴瘤》2017年第12期752-755,共4页Journal of Leukemia & Lymphoma

摘　　要：目的 分析老年骨髓增生异常综合征（MDS）患者因血小板减少应用重组人白细胞介素11（rhIL-11）后出现心律失常的情况,探讨rhIL-11诱发心律失常的可能机制.方法 回顾性分析2例应用rhIL-11后出现心律失常的MDS患者资料.动态观察rhIL-11使用后出现心律失常的时间及使用前、出现心律失常时和停用rhIL-11恢复窦性心律后患者血红蛋白、心电图、心肌酶、肌钙蛋白Ⅰ（cTnⅠ）、氨基末端脑钠肽前体（NT-proBNP）变化,以及心律失常期间心脏彩色超声、动态心电图监测情况.结果 病例1、2用药前血小板计数分别为2×109/L、3×109/L,使用rhIL-11后出现心律失常的时间分别为第11、14天,心电图表现为房颤伴快速心室率,动态心电图监测提示晕厥因窦性停搏所致,考虑为心源性晕厥,心脏超声提示射血分数（EF）值在正常范围.肌酸激酶、肌酸激酶同工酶、天冬氨酸氨基转移酶、乳酸脱氢酶、cTnⅠ用药前后无明显升高或降低趋势,而NT-proBNP升高明显.患者经停用rhIL-11、利尿等治疗后无晕厥发作,心电图恢复窦性心律,NT-proBNP明显下降.结论 老年MDS患者使用rhIL-11可能诱发心律失常,经停药及限钠饮食、利尿等治疗后可恢复,但使用过程中建议高度关注心脏相关症状和体征,动态监测NT-proBNP评估心功能并及时予以治疗.Objective To analyze the arrhythmia after treatment with recombinant human interleukin 11 （rhIL-11） because of down-regulating platelet in elderly patients with myelodysplastic syndromes （MDS）, and to investigate the possible mechanism of arrhythmia induced by in MDS patients. Methods The data of 2 MDS patients with arrhythmia after rhIL-11 therapy were analyzed retrospectively. The patients＇hemoglobin, electrocardiogram （ECG）, myocardial enzymes, cardiac troponin Ⅰ （cTnⅠ）, N-terminal pro brain natriuretic peptide （NT-proBNP） changes, as well as cardiac ultrasonography and Holter monitoring during arrhythmia were dynamically observed before and after use of rhIL-11, at the time of arrhythmia and restoring sinus rhythm after the withdrawal of rhIL-11. Results Before the use of rhIL-11, blood platelet count of patient 1 and patient 2 was 2×109/L and 3×109/L respectively. Arrhythmias occurred in the two patients at 11st and 14th days respectively. ECG showed atrial fibrillation with rapid ventricular rate, and dynamic ECG monitoring showed that syncope was caused by sinus arrest due to cardiac cardiogenic syncope. Heart＆nbsp;ultrasound prompted ejection fraction （EF） values in the normal range. Creatine kinase, creatine kinase isoenzymes, aspartate transaminase, lactate dehydrogenase, and cTnⅠ had no obvious increase or decrease after rhIL-11 treatment, but NT-proBNP was increased significantly. After discontinuation of rhIL-11 and diuretic treatment, no syncope occurred. ECG restored sinus rhythm, and NT-proBNP was decreased significantly. Conclusion rhIL-11 in elderly MDS patients may induce arrhythmia, which can be restored after drug withdrawal, limited sodium diet and diuretic treatment, but much attention should be paid to the heart-related symptoms and signs, dynamic monitoring of NT-proBNP and timely treatment.

关 键 词：骨髓增生异常综合征 重组人白细胞介素11 心律失常 

分 类 号：R541.7[医药卫生—心血管疾病] R551.3[医药卫生—内科学]